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Mr Milburn's good hospital guide

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My hospital has just been awarded the 'coveted' top ranking of three
stars in the NHS league table.
Needless to say the Chief Executive and Chairman are delighted and have
earned big browny points
in Mr. Milburn's eyes - future honours list will be scoured for their just
awards.

The kidney unit in which I work has 65 patients on the waiting list
to start dialysis for their kidney failure.
There are 10 dialysis stations lying empty which could accomodate all of
them if the revenue was forthcoming,
which it hasn't been for many many months. Only when someone dies or is
transplanted will a space become available. This state of affairs does
not exist anywhere in Europe, even in Bulgaria , one of the poorest
countries !

A number of our patients require parathryroidectomy for secondary
hyperparathyroism, a well-known complication of chronic real failure. It
takes 3-4 months to see the overstreached surgeon and a further 9-12
months before he can do the operation. The patients are put on a 'pre-
list list ' and after 3-4 months are contacted to find out when in the
next 6-9 months they would like to have the operation. This is called
patients choice in selecting the date ! On that date they have to first
ring the hospital to find out if there is a bed available. Not uncommonly
there is no bed because of overspill from the medical wards onto the
surgical wards e.g. winter bed crises, and the operation is postponed for
weeks or months. A colleague of mine in Belgium tells me the waiting time
to see a surgeon and have this type of operation is two weeks, yet the
United Kingdom is one of the seven richest nations in the world !

These are but a few examples from just one unit in this hospital, and
we got the highest position of 3 stars. I
shudder to thing what it must be like in those hospitals with 2 , 1 or 0
stars.

The NHS as it is currently structured, financed and managed with its
politically orientated objectives has failed the public who use and the
health professionals who work in it.

Prof. Klein's remarks made me think about comparing NHS performance
to a downhill bicycle race. The real way to win the Tour de France multi-
stage bicycle race is not to try to win each stage of the race, but to
place reasonably high on each stage; indeed, one can even place quite low
on some stages, as long as overall one is generally better than anyone
else. But to endeavour to win each stage can lead to failure. Like the
NHS, the stages of the Tour are different -- some are long distance, some
are mountain climbs. It is unrealistic to expect a winner of one to be a
winner of all. This much is known and this much is reality.

In the real world of bicycle races, and as Klein notes, restaurants,
there is a commonsensical awareness of the meaning of variance in
performance, and that such variance does not always equal failure.
Adopting a model of hospital performance that attempts to shoehorn the
real world into a simulation model of reality (health policy, for short)
will probably fail to address our real world concerns about hospital
performance. The Siren call of perfect measurement is seductive and
misleading.